I’ve been thinking a lot about sleep lately, and I’m trying to understand the nuances of how my BG levels affect sleep quality. I chose to call this topic “optimal” because I’m not talking about avoiding highs, lows and the interruptions that follow. Rather, I’m thinking of the level that should be targeted.
Assuming that we are able to stay reasonably flat at some level, where should this level be? Do you notice any difference if you’re at, say, 4.5 vs 7.5, if you’re stable in both cases? Personally, I think my sleep gets at least a little bit better if I’m slightly lower, but still within range, but it’s hard to tell.
IMO, we should try to mimic non-diabetic BGs, but that comes with a lot of nuances. It is ideal to run in a “normal” range as much as possible, but for a lot of people that’s tough to do without catching lows. So there’s a ton of variability I’m sure in what people try to target while sleeping, and I’m sure that access to CGM or the presence of a sleeping partner influences one’s preferences/target goals.
Personally I see sleep as a long time frame in my day that has potential to skew my average BG (or A1c or diabetes management). Because it is a large proportion of each 24 hours, while sleeping I try to target around 70-80mg/dL (3.9-4.5mmol/L), using increased temp basals (to drive my BG down) and basal IQ (to keep me from going low). Obviously each night is not perfect by any means. I do think I feel better waking up knowing I was sleeping in a lower range, but I also admit a lot of that is probably mental. It’s super hard to tell…
Something I’ve been noticing lately is that I tend to have a higher incidence of nightmares while sleeping on the higher side. Not sure if anyone else has noticed that??
I find this to be true as well. The higher my BGs are the lower quality of sleep I get and the weirder my dreams get. If my BGs are +200, I might as well get up as I will just toss and turn for hours. Conversely, if my BGs are < 65 I also have poor sleep and strangely vivid dreams about life or death situations. I try (with minor success) to stay between 80 and 150 at night which if I am lucky might happen 2-3x/week.
If my BG is in the 60s, I’ll tend to have more nightmares /vivid dreams which will usually wake me, and I’ll remember them (I don’t normally remember dreams otherwise). They often are paranoid conspiracy or life /death type.
I like to be 5 to 6 (90 to 110) through the night.
If I’m lower I get very restless. If I go low enough that I have to treat, then I’m usually awake for an hour or even two afterwards.
If I’m higher I spend the night waking up every half-hour or so to check my Dexcom to see if my last correction worked and then decide whether to do another correction and maybe get up and go to the kitchen to do a test to make sure my Dexcom is accurate and then repeat all the above every half-hour.
Topics about range always make me wonder if people have different bg operating ranges or if I’m hyper-unaware and hypophobic. I sleep better on the high side, probably 120+. Under that I wake up or have difficutly falling asleep. Probably worth noting I don’t use a CGM.
Lately I’ve been struggling with highs, +1 to nightmares when very high.
I work under the assumption that your body works in the range it is used to being in. So if you regularly run 300, being at 100 will feel strange and low.
That was a lot of interesting responses! Good point by @LarissaW about non-diabetic BG numbers. It makes sense that it should be best to target the lower end of the range. I also agree with @Chris about the body getting used to a particular range. Personally, I would like to teach my body to prefer a “normal” level.
Those of you with pumps, do you find that you require more basal overnight? I’m on MDI and it’s mostly okay. Meals and exercise will cause some highs and lows, but when I’m still and fasting, I end up between 4 and 8. The slightly annoying part is that I’m often closer to 8 when sleeping and sometimes get low when awake. Right now I’m not sure if I should just be happy than I’m in range and accept it, or if it’s worthwhile to tweak it further.
totally anecdotal, but I notice that Samson wakes up most refreshed if he’s running above 80 and below about 110 for most of the night. That said, he doesn’t have a perfectly normal blood sugar profile all day, so it could be that someone who’s running tighter would prefer to be even lower?
Yes! That’s what I’ve heard from a decent amount of people. @Chris put it well above:
I by no means think targeting 70 at night is right or preferable for everyone! That’s just where I feel best (again probably partly mental there.)
Nights that I don’t have a CGM on I tend to aim for a higher target just for peace of mind. But if I can maximize my time in my preferred range overnight, then I try to! (not always successfully!)
I rarely go low during the night, unless I’ve messed up a bolus late in the evening. The pattern I’m seeing right now is higher values while sleeping and lower ones during the day. It’s still in range though, unless there’s eating or exercise involved.
For now I think I’ll just keep an eye on it, but if I eventually consider a pump, then a higher nighttime basal would definitely be something to consider.
I am so glad to have read this topic. it is a true testament to how YDMV kind of thing.
I need significantly LESS basal during the night than I do during the daytime. it makes little sense to me, bc during the day is when I am most active; at night I’m just lying on my side for 8 - 10 hours. my only activity during the night takes place in my dreams
my preferred, most comfortable overnight BGs are 75-95. I sleep soundly and comfortably. I try and keep my BGs between 80-95 throughout the day. But, I am also hypo-unaware. I could be in my 60s for hours and not notice it at all. I don’t really notice I am low until I am around 50ish; then I start having trouble seeing, I can see stars and spotting bright lights, and I get a metallic taste in my mouth. in my 40s I start to shake.
Thank you all for this topic as I’ve been trying to figure this sleep issue out as well. I’ve found both highs and lows make for restless sleep followed by the next day or two with numbers all over the place. If it’s been a low night I tend to rebound the next day with harder to control highs, and visa versa. The other night I went down into the 50’s per blood, (FreeStyle Libre CGM in the 40’s). Took gluc tabs and came up but the rest of the night was restless. The next day I didn’t feel good at all, headache, no energy, spacey… much more then just a bad night’s sleep. BS stayed on the lower side the next day - 90 to 114. Before bed I was up to 139. Got up to 152 at 5am, adjusted with 1 unit ( I use Novolog pen) which would usually bring me down nicely but it didn’t. I spent the day with high numbers (for me) getting up to the 170’s. I shot up more then my usual amount, was extra careful with what I ate and made sure to have a good workout. I had more energy but still had the headache. Sleep was better that night and the next day I was pretty much back to my “normal”.
Could it be that the body is trying balance in some way…? As I’m only 31/2 years into this world of LADA the learning curve is still big, but am feeling I’d rather be a little higher through the night then lower. I think I sleep better when I’m on the high side of my normal rather than my acceptable low side.
Thank you again,
Cheers
@SFLADA - from my experience, if I wake up in range, I tend to have a better day of BGs. If I wake up high or low and I’m trying to get my day started and am rushing (as per usual) to workout/work/school then that makes it harder to “stick the landing” and end up at a decent number, and then I’ll end up chasing an in-range number for what feels like all day.
I know that there was a clinical trial being conducted to see if overnight in range BGs are associated with a better TIR the next day. Not sure if they’ve released the data, but should be interesting!
As far as a high rebound following a night of lows - it could be due to stress hormones peaking more than they usually do, causing more insulin resistance and a harder time to get the BG to come down. But it could be lots of factors!! Keeping a nice BG overnight is so tough, and it definitely affects me the next day as well if I’m out of range all night or waking up to correct a low or high.
